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Winter 2018-Patient Assessment > Respiratory Assessment-Review > Flashcards

Respiratory Assessment-Review Flashcards

1
Q

Suprasternal Notch

A

Top of the manubrium and located by the depression at the base of the neck

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2
Q

Xiphoid Process Topgraphy

A

Palpitate downwards from the glodious to the bottom of the sternum

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3
Q

C7 Topography

A

Have the pt. extend forward and down and at the base of the neck is C7

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4
Q

T1-T12 Topography

A

T1 is located right below C7

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5
Q

Scapulae Topography

A

Pt. raise arms above head

The inferior border can be identified

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6
Q

Sternal Angle Topography

A

Palpitate down from suprasternal notch until you feel the ridge that seperates manibrium and gladiolus

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7
Q

Midscapular Line Topography

A

On posterior on either side of midscapular line (left and right) located through the inferior angle of the scapula

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8
Q

Midaxillary Line Topography

A

Located on lateral chest and divides lateral chest into two equal halves

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9
Q

Diaphragm Topography

A

End of Expiration

Right: T9 posterior and the 5th rib anterior

Left: T10 posterior and the 6th rib anterior

At the inspirtory position depends on the pt. position and the force of the breath

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10
Q

Tracheal Bifurcation Topography

A

Anterior-Behind sternal angle

Posterior-T4

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11
Q

Superior Lung Border Topography

A

Anterior-2-4 cm above medial 3rd of clavicle

Posterior-Inline with T1

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12
Q

Gladiouslus topography

A

Below the sternal angle is the gladious (sternal body)

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13
Q

Manubrium Topography

A

From suprasternal notch directly below manubrium

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14
Q

Second Rib Topography

A

The 2nd rib articulates with sternal angle from here you can palpitate the rest of the ribs

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15
Q

Midsternal Line Topography

A

On anterior chest will divide chest into 2 equal halves directly down from the middle of the line

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16
Q

Midclavicular Topography

A

Left and right of the midsternal line drawn through the clavicular midpoint

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17
Q

Midspinal Line

A

On posterior chest and divides the back into 2 equal points

Directly down center of spine

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18
Q

Posterior Topography

A

Parallel midaxillary line on the posterior side

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19
Q

Anterior Axillary Line

A

Parallel midaxillary line on the anterior side

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20
Q

Cyantoic or Pale

A

Central Cyanosis: Cyanosis of the trunk or core, can be visible around the mouth and lips (mucus membrane) and indicates poor oxygenation

Peripheral Cyanosis: Also known as acrocyanosis and is cyanosis of the hands, feet, ear lobes, nose, and lips and indicates poor perfusion

Pallor can be cause by anemia

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21
Q

I:E Ratio

A

A normal I:E ratio is 1:2 or 1:2.5

When there is a severe airway obstruction there will be an increase expiratory phase

If there is a acute ariway obstruction there will be an increased inspiratory phase

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22
Q

Retractions

A

Large swings in pleural pressure can result in the sinking in of soft tissue upon inspiration

Intercostal, subcostal, or supraclavicualr (may tug at the trachea)

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23
Q

Pulsus Paradoxus

A

Palpitated pulse strength will decrease with inspiration

Seen in severe asthma

Can be secondary to negative thoracic pressure due to the increase return to the IVC and decreased systolic pressure

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24
Q

Hoover Signs

A

Inward movement of ribs cage during inspiration (instead of outward movement which is normal)

Implies a flat but functioning diaphram

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25
Q

Abdominal Paradoxics

A

Fatigue of the diaphragm in the face of increase WOB is evidenced by the abdomen sinking inwards on inspiration

Normally the abdomen will move outwards with inspiration in sync with the thorax

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26
Q

What Does it Mean When the Whites of the Eye are Yellow?

A

This is a sign of jandious, which is indicative of liver disease

The liver may result in problem return fluid to the irght side of the heart and right sided heart failure

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27
Q

Pursed Lip Breathing

A

Allows the patient to slow their expiratory phase in order to help release trapped air and provide resistane in exhalation through providing back pressure and prevent premature airway collapse

Common in COPD and may be taught to do it or may do it naturally

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28
Q

Nasal Flaring

A

External nares flare outwards during inhalation and suggests an increased WOB

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29
Q

Diaphoresis

A

Sweating

Common with acute respirtory distress, severe pain, and myocardial infarction

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30
Q

PERRLA

A

Pupil, Equal, Round, Reactive to light, Accomadation

Drooping of the eyelid signals the 3rd cranial nerve damage and is known as ptosis (early warning sigh of respirtory failure)

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31
Q

Mydriasis

A

Pupils become dilated and fixed

May be due to catecholamine, atrophine, etc

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32
Q

Miosis

A

Pinpoint pupils

Parasymathetic stimulants (ex. opiates)

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33
Q

Diplopia

A

Double vision

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34
Q

Nystagmus

A

Involuntary cyclic moveemnt of eyeball

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35
Q

What are we looking for in the neck

A
  • Tracheal Position-Laryns is the easiest to palpitate and if you follow it down you can find the trachea (see if it is shifted)
  • Carotid pulse
  • JVP and JVD
  • Lymph glands
  • Thryoid size and position
  • Turmour or masses
  • Accessory muscle use
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36
Q

Tracheal Shift-Atelectasis or Lung Resection

A

Will reduce lung volume and trachea will shift towards the affected side

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37
Q

Tracheal Shift-Tension Pneumothorax, Pleural Effusion, and Lung Tumor

A

Trachea will move away from affected side because the excessive air/fluid/tissue will push the trachea towards unaffected side

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38
Q

JVD

A

Will be hard to see in an obese or muscular neck

Measured at the end of a full exhalation

Most common cause if right sided heart failure

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39
Q

Pectus Carinatum

A

Sternum protrudes outwards

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40
Q

Pectus Excavatum

A

Bottom edge of sternum is depressed inwards

41
Q

Bifid Sternum

A

Congenital abnormality

Where 2 halves do not fuse together and are split

42
Q

Kyphosis

A

Spine has a abnormal AP curvature (front to back)

43
Q

Kyphoscoliosis

A

Combination of increase abnomal AP curvature and a lateral curvature

44
Q

Barrel Chest

A

Increase AP diameter with a loss of normal rib slope in relation to the spine and a development of accessory muscle overuse

Common in COPD

45
Q

Flail Chest

A

A section of the rib cage fracture due to the injury and moves freely paradoxically

Move in on inspiration and bulges on expiration

46
Q

Vocal Fremitus

A

Vibration created by the vocal cords during phonation which are transmitted through the parenchyma to the chest wall

Bronchial obstructon (mucosal plug, forgein object) or when plaural space lining becomes filled wih air (pnemothorax) or fluid (plaural effusion) will decrease vocal fremitus (may even be absent)

47
Q

Tactile Fremitus

A

When vibrations created by the vocal cords during phonation are felt on the chest wall

Assessment-Pt. repeats a words while the RT palpitates thorax

48
Q

Increased Tactile Fremitus

A

Conditions that increase the density of the lung will result in a increased intensity of fremitus (lungs are more solid)

Pneumonia

Lung tumor or mass

Atelectasis (with patent bronchiole)

49
Q

Decreased Tactile Fremitus

A

Will occur in areas of a decreased density (less solid and more air)

Unilateral-Bronchial obstruction, pneumothorax, pleural effusion

Bilateral-COPD with hyperinflation, muscular, or obese

50
Q

Absent Fremitus

A

No ventilation

51
Q

Thoracic Expansion- Assessment

A

Have pt. breath all the way out

Place hands on posterior of chest with thumbs at T8 midline with fingers secure on lateral sides of the chest

Note the movement of the thumbs

Normal-Thumb move 3-5 cm

52
Q

Decrease Thoracic Expansion

A

Decreased Bilaterally-COPD, Neuromuscular disease

Descreased Unilaterally-Lobar consolidation, atelectasis, pleural effusion, pneumothorax

53
Q

Chest Wall Palpitation

A

Chest wall skin can be palpated for condition and temperature (perfusion)

Can also be palpated to detcted air leaks from the lungs that have moved to just under the skin

54
Q

Subcutaneous Emphysema

A

When air leaks from the lungs into subcutaneous tissue, and fine beads of air will produce a crackling sounds and senation when the chest wall is palpitated which is known as subcutaneous emphysema

Trauma (torn lungs and trachea) over distension via positive pressure ventilation

Will feel like rice krispies

55
Q

Precussion

A

Tapping on the chest

Effect percussion produces vibration of lung to a depth of 5-7cm

Normal resonance is low and clear

56
Q

Increase Resonance (Percussion)

A

Lower in pitch and louder than a normal drum

Occur in conditions where there is more air (hyperinflation)- COPD, asthma, pneumothorax

57
Q

Decreased Resonance (Percussion)

A

Higher in pitch, shorter duration, and softer than normal

Occurs in conditions of increased density consolidations, tumor, atelectasis, pleural effusion, and hemothorax

58
Q

Hyperesonance Resonance (Percussion)

A

Hollow sound

Can be in air trapping

Ex. Severe asthma attack

59
Q

Diaphragmatic Excursion

A

The range of diaphragm movement can be estimated through percussion and assessed on the posterior chest

To assess the pt. should take a deep breath and hold it. The clinician can determine the lowest margin of resonance through percussion over the lower lung field moveing downwards in small incrememts until a change has been heard. The a pt. will do a maximum exhalation and the percussion process has been repeated

60
Q

Stethoscope

A

Bell-Used for low pitch sounds

Diaphragm-High pitch sounds

To perform an asculatation have the pt. take a deep breath with their mouth open and pt. sittign up

61
Q

4 Charateristics of Breaths Sounds

A
  1. Pitch
  2. Amplitude
  3. Distinctiveness
62
Q

Tracheal Breaths Sounds

A

Normal to be heard over the tracheal area

High pitche and loud (harsh)

Expiratory slightly louder than inspiratory

63
Q

Bronchovesicular Breath Sounds

A

Normal in the upper 1/2 of the sternum in the front and between the scapula on the back

Medium in pitch and loudness

E=I

64
Q

Vesicular Breath Sounds

A

Normal in the lung periphery

lowest pitch and quiestest sound

mostly I with minimal E

65
Q

Adventitious Sounds Can be Described As:

A

Continuous: Longer than 25 sec (wheeze, stridor)

Discontinuous: Intermittent, short duration, less than 20 sec (crackles, rubs)

Bronchial Breath Sounds: Considered abnormal when in areas when vesicular breath sounds should be heard instead sound tracheal

66
Q

Wheezes

A

Musical notes generated by vibrations of narrowed airways as air passes through at a high velocity

Low pitched wheezes can be cause by sputum in the airway and can disspear with a cough

Diameter of the airway is reduced-Bronchospasm, mucosal edema or obstruction

Pitch of wheeze is affected by the diameter.

Narrow/More Compressed airway=higher pitch (will not disappear with a cough)

A louder wheeze is good because is means that air is moveing

If the wheeze is heard loudest over the neck it means that the upper airway is the source of the obsruction

67
Q

Wheeze-Polyphonic

A

Limited to exhalation

Several muscial notes

Indicative of multiple airway involvement

68
Q

Wheeze-Monophonic

A

Single musical note indicating single bronchus obstruction

Can be on I or E

69
Q

Stridor

A

Continuous sound heard on inhalation

Occurs durign an upper airway obstruction

Loud and high pitched

Can be heard without a scope

70
Q

Crackles

A

Caused by movement of excessive secretions/fluid in the airway as air passes through a collapsed airway/popping open

Discontinuous

71
Q

Coarse Crackles

A

Also called rhonchi

May sound wet

Heard on I and E

May or may not clear with a cough

72
Q

Early Inspiratory Crackles

A

The longer more proximal bronchi may close during expiration, and when there is a abnormal increase in bronchial compliance

Ex. COPD

These crackles tend to be few in number and can be loud or faint

Often transmitted by the mouth and not silenced through a cough or change in position

73
Q

Late Inspiratory Crackles

A

Peripheral alveoli and airway close during exhalation when surronding intrathoracic pressure increases. The sudden openign of the peripheral airway will produce crackles

More common in dependant region of the lung due to gravitational stress predipositioning the pheripheral airway to collapse at exhalation

Recurrent rhythm

May clear with posture change or inspiratory manuvers

Cough or max exhalation may reporduce these crackles

Ex. Disease the reduce lung volume such as pulmonary edema, atelectasis, pneumonia, fibrosis

74
Q

Pleural Friction Rub

A

Creakign or grinding sound

occur when irritated inflamed pleural surfaces rub together on I and E

Gets louder with deep breathing

May be very painful and worsen on inspiration

Assocaited with pneumonia, TB, pleurisy, pleural effusion

75
Q

Bronchophony

A

Blue balloons

Increased intensity and clarity of resonance

Same mechanism as vocal fremitus

Increased clarity with consolidation

76
Q

Whispering Pectirutiquy

A

Whispered sounds (usually muffled and quiet) are louder

Increased clarity with consolidation

77
Q

Egophony

A

Nasal e-e-e soudn which sounds like a-a-a

Compressed lung above pleural effusion

78
Q

Point of Maximal Impact

A

Also known as systolic thrust

Location-Midclavicular in the 5th intercostal space

Factor for shifts-Will shift in the same direction as tracheal shift, towards affected side of lung collapse, away from affect side in pneumothorax, will be shifted to the right closer to the gut in emphysema

79
Q

Normal Heart Sounds

A

S1-Lubb, closure of AV Valve (mitral and tricuspid), correspond with onset of systole, louder than S2 at apex

S2-Dubb, closure of semilunar vlaves (aortic and pulmonic) beginning of ventricular diastole, louder at bases

80
Q

S3

A

Heard after S2

Occur in early distole during rapid ventricular filling

Also known as ventricular gallop

Normal in children and yong adults due to an increase in diastolic volume

Observed in CAD, cardiomyopathies, incompenetent valves (murmurs)

81
Q

Split S2/ P2

A

Louder valve closure or valve does not close

Caued by pulmonary hypotension

82
Q

S4

A

Heard just before S1, late diastole, occur during atrial contraction

Also known as atrial gallop

Normal in children

Adnormal with hypotension, aortic stenosis, LV MI

There is also a murmur and gallops that are due to diseases or structural defects

Heart Sounds can also be muffled in -Cardiac tamponade, pneumothorax, obesity, pneumopericardium

83
Q

Acites

A

Serous fluid in the peritoneal cavity due to heart failure, renal failure, liver failure (cirrhosis), and sodium retentsion

Flui imbalance issue

84
Q

Increase size of right upper quadrant

A

Heptomagaly due to right sided heart failure

85
Q

Clubbing

A

Painless enlarge of distal phalanges

Ex. Congenital heart disease, cyanotic, brochogenic, carcinoma, COPD, cycstic fibrosis, bronchiectasis

Unknown mechanism

86
Q

Cyanosis

A

Occurs when more than 5.0 g/dL of reduced Hgb exists

Intensity of cyanosis increases with Hbg

87
Q

Polycythemia

A

Polycythemoa shows cyanosis at a lesser degree of tissue hypoxemia

Will see signs of cyanosis at a high O2 saturation compared to anemic pt.

88
Q

Anemia

A

Anemia will not show sugns of cyanosis until severe tissue hypoxemia exists

Pt. will have less RBC so there will be a lower O2 saturation level (~50%) before you see signs of hypoxia

89
Q

Normal Hemoglobin Levels

A

15g/dL

or 150 g/L

90
Q

Pedal Edema

A

Accumulation of fluid in ankles due to right sided heart failure

91
Q

Pitting Edema

A

When clinican presses upon ankle making an indentation and remains there for a while

92
Q

Peripheral Skin Temperature

A

Cool skin temperature can indicate decreased peripheral perfusion due to vasoconstriction or poor cardiac output

93
Q

Biot’s

A

Irregular breathing pattern with periods of apnea

94
Q

Cheyne-Strokes Breathing

A

Breath change in dpeth with periods of apnea

Ex. Congestive heart failure

95
Q

Kussmaul Breathing

A

Deep and fast

Can be due to metabolic acidosis

96
Q

Primary Muscle of Ventilation

A

Diaphragm and Intercostal Muscles

Ment tend to breath with diagraph and women tend to breath with intercostal muscles and diagphram

97
Q

Respiratory Alternans

A

Periods of breathing using only chest wall followed by diaphram breathing

Diaphram fatigue

98
Q

Accessory Muscles

A

Inspiration-Scalene, sternocleidomastoid, external intercostal

Expiration-Internal intercostals, abdominal

Winter 2018-Patient Assessment (7 decks)

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